Wednesday, February 5, 2014

On medical marijuana, doctors split on benefits, risks

David Mulford has a heart condition, several hernias and severe muscle spasms. He had tried marijuana in the past and noticed that it relieved his pain.

A few years ago, after Mulford testified at a hearing on medical pot at the Statehouse in Topeka, a man approached and gave him a sample of cannabis oil, claiming it would alleviate his symptoms.

“The results were incredible, absolutely beyond any expectation I may have had,” said Mulford, 55, of Hutchinson. “Over the last 20-some years, my physicians had literally thrown up their hands. I’d tried every medication available for muscle spasms ... and found they were either ineffective or had side effects I couldn’t handle. I was basically at the end of my straw.”

But since cannabis is illegal in Kansas, even for medical purposes, Mulford stopped using the oil, afraid of getting himself or his supplier in trouble. Now, Mulford is homebound, out of full-time work, close to needing surgery — all, he says, because he doesn’t have access to medical marijuana.

Many patients and advocates say medical marijuana can help alleviate such conditions as pain, nausea and anxiety, and benefit patients with diseases like AIDS, cancer and multiple sclerosis. But because of a lack of research in the United States, the debate over the medicinal benefits of cannabis has yet to be settled.

Twenty states and the District of Columbia have legalized the drug for medical uses, but while several medical marijuana bills have been introduced in the Kansas Legislature in recent years, none has reached the floor for a vote.

Two contrary opinions

Eric Voth and Jon Hauxwell are probably the two leading experts in Kansas on the medicinal value of marijuana. And their opinions on the topic couldn’t be more diametrically opposed.

Voth, a Topeka internist, says medical marijuana is just a front for those who want to legalize pot completely, while Hauxwell, a retired family doctor who lives near Hays, claims the drug can be a valuable tool for health care providers.

Never before, says Voth, have voters decided on whether a given substance should be used for medical purposes. Normally, he notes, medications go through a rigorous process of research, development and approval by the Food and Drug Administration.

Voth admits that some cannabinoids, of which there are dozens in marijuana, probably have medical benefits, so researchers should extract those and put them into a pill or injectable form whose strength can be regulated.

“Show me anywhere where we embrace smoking a medication,” he said.

Added Voth: “I think the medical issue is a fraud, and it’s a Trojan horse. It’s purely to try to turn the public’s opinion.”

Hauxwell argues otherwise. He believes medical marijuana can reduce pain, particularly that of the neuropathic variety, and that it’s less addictive and deadly than many commonly prescribed opiate painkillers.

Neuropathic pain is where the nerve fibers send incorrect signals to other pain centers. An example is phantom limb syndrome.

“Any medication is a balance between risk and benefit — cannabis is no different,” he said. “But its benefits for properly selected patients considerably outweigh the risks for the individual.”

Hauxwell went on to say that, unlike cigarettes, marijuana hasn’t been found to cause lung cancer, though he wouldn’t recommend it to patients with a prior lung condition; instead, they’d have the option of vaporizing or eating the drug. He said pot’s classification as a Schedule I controlled substance (the same as heroin and ecstasy) makes it more difficult for the medical community to research its effectiveness. And, he added, he would never recommend its use to a child with a less-than-serous ailment — many urge cannabis as a cure for childhood seizures — as marijuana can affect brain development.

Limited local knowledge

Local doctors, if they’re even willing to speak on the record on such a controversial topic, don’t seem know a lot about medical marijuana because, it being illegal, they don’t have to.

“I think it’s just a fault of the ignorance — it’s not in our repertoire yet, especially being a Kansas physician,” said Ajay Tejwani, a Lawrence radiation oncologist, adding: “For the most part, I don’t think physicians would have an issue prescribing it if the research showed that it worked.”

Lawrence family doctor Steven Bruner isn’t against medicinal marijuana, per se, he just hasn’t studied it. But he worries that, if it were to be legalized, it would be used for more that just medical purposes.

“In most places where it’s available for medicinal use, it’s being prescribed somewhat loosely, and I have no reason to believe some physicians in Kansas wouldn’t be doing the same thing,” he said. “It’s a gateway drug, not for hard drugs, but for recreational marijuana use.”

Ryan Neuhofel, a primary care doctor in Lawrence, said that if he were able to prescribe marijuana, he would do so the same as he does with any other medication: with caution.

“Marijuana is certainly not a safe or harmless substance, but its side effect profile is comparable, and in many cases better, than many commonly used prescription drugs,” he said. “My concern with legalizing marijuana solely in a medical setting is the burden it would place upon the health care system for recreational users seeking ‘prescriptions.’”

Allie Ramsey, an Overland Park nurse who researched medical marijuana as a student in the Kansas University School of Nursing, noted that one of the oldest medical texts in the world — the Chinese “Shen-nung Pen-tsao Ching” (or “Divine Farmer’s Classic of Materia Medica”), written approximately 2,000 years ago — mentions using marijuana to treat digestive disorders and rheumatic pain, and that doctors in the U.S. prescribed it prior to marijuana prohibition.

Ramsey became interested in the topic after seeing the success that two aunts with terminal cancer had with dronabinol, a legal cannabinoid already prescribed by doctors.

“I saw it greatly affect their lives,” she said. “It decreased their nausea and vomiting significantly, to the point where they were able to eat again.”

Lawrence resident Patrick Wilbur, a member of the state Libertarian Party and marijuana advocacy group Kansas for Change, said he became sold on the benefits of medicinal marijuana after working an advocacy booth at the state fair a few years back, when he was approached by numerous people who told him how pot helped with their physical ailments.

“Of course there were just as many people who just wanted to smoke weed,” he said, “but I never realized the (medical) need was that great.”

User says it works

Dylan, a Lawrence resident who requested that his last name not be included because he uses cannabis illegally, said that after years of trying different treatments and medications for his back and neck pain, the result of a childhood car accident, he tried pot for the first time at a party in high school. It immediately helped with his pain and mobility, Dylan said, and got him off opiate painkillers that had previously left him sick and addicted.

Dylan also watched the way medical cannabis alleviated his uncle’s side effects from chemotherapy, reviving his appetite, energy and ability to sleep. The uncle was getting the marijuana from a friend who would drive to Colorado, where it was legal, but his supply was cut off after the man was arrested. The condition of Dylan’s uncle took a turn for the worse and he died soon after. Dylan blames the loss of his medical marijuana supply.

Eventually, Dylan was himself arrested for marijuana possession and forced to give up smoking pot. He endured more surgeries, epidurals and pills, some of which made him so sick and out of it he failed out of college. But a few years ago, finally off probation, Dylan said, he went back to marijuana, and the therapeutic effects were the same. Now in his 20s, he works at a local restaurant and is back attending Kansas University.

“I haven’t had a surgery in over six years because of the healing powers of cannabis,” he said. “Why should I be arrested, thrown in jail and forced to spend thousands of dollars for trying to live my life pain-free?”